The long-term objective of this project is to enhance the understanding of infertility in sub-Saharan Africa. Previous analyses have established that infertility in sub-Saharan Africa is determined by multiple factor, including evidence that regional and local factors are important determinants. The present proposal goes beyond these previous 'country level' analyses of infertility by studying a single local African community in depth. The proposed work will add clinical evaluation of infertile couples and the measurement of biological markers to community-based survey data obtained from both partners in a couple. By studying on community, this project will be able to integrate the biomedical, demographic, and anthropologic analyses of infertility, and to integrate knowledge of female, male, and couple factor of infertility. The quantitative analyses of survey data will include estimates of the prevalence of primary and secondary infertility by age of the woman, estimates of the risk factors of primary infertility based on a Cox model, and estimates of the risk factors of secondary infertility using a discrete logistic regression. The quantitative finding will be interpreted together with the findings of the qualitative analysis, which includes an ethnographic study and a content analysis of in depth interviews using software for qualitative analysis (QSR NUD IST). It is important to understand infertility for several reasons. Infertility is a strong indicator of poor health, and infertility can largely be prevented with appropriate public health interventions. In addition, infertility depresses population growth. Finally, infertility has serious social consequences, such as the ostracism of women which leads to strained gender relations. To address these issues the research has seven aims: 1. To estimate the prevalence of primary and secondary infertility. 2. To determine the proportions of female, male, and couple factors infertility. 3. To examine the risk factors of infertility. 4. To investigate local perceptions of the causes of infertility. 5. To describe treatment options and services that are currently in use, including traditional local healers, medical professionals, and self-treatment. A basic protocol for the recommended treatment of infertility will be developed. 6. To analyze the social implications of infertility. 7. To assess the demographic implications of infertility.